Provider Demographics
NPI:1487165338
Name:MOHAMED IKBAL ALI
Entity type:Organization
Organization Name:MOHAMED IKBAL ALI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARICAR
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-391-7751
Mailing Address - Street 1:450 SUTTER ST RM 1905
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4103
Mailing Address - Country:US
Mailing Address - Phone:415-391-7751
Mailing Address - Fax:415-391-7357
Practice Address - Street 1:450 SUTTER ST RM 1905
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4103
Practice Address - Country:US
Practice Address - Phone:415-391-7751
Practice Address - Fax:415-391-7357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA400541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA40054OtherDENTAL BOARD OF CALIFORNIA